Chronic Pain management Flashcards
How can you evaluate chronic pain?
- H&P
- Psychological evaluation
- electromyography
- nerve conduction studies
- muscle potentials
- multidisciplinary approach
What is the chronic pain treatment continuum?
(picture)
What are some medications used for chronic pain managment?
- NSAIDS/Acetaminophen
- opioids
- tramadol
- antidepressant drugs
- antiepileptic drugs
- corticosteroids
- muscle relaxants
How are Tricyclic antidepressants used to treat chronic pain?
How are they dose?
Side effects?
Example of drus?
- Elevate mood, help with sleep
- block reuptake of serotonin and norepinephrine at the neuronal membrane
- potentiate narcotic analgesics
- Dosing
- use smaller doses than indicated for depression
- must monitor drug levels
- SE
- anticholinergic (dry mouth, sedation, fatigue, orthostatic hypotension, arrhythmias)
- Examples: amitriptyline, Doxepin
How are Anticonvulsant drugs used to treat chronic pain?
Uses?
Examples?
SE?
- They alter the ion channels along the nerve fiber, thereby blocking pain stimuli by blocking the action potential
- Used to treat neuropathic pain resulting from lesions to the Peripheral nervous system (DM, herpes) or CNS (stroke)
- Examples: carbamazepine, phenytoin, gabapentin, and clonazampan
- SE:
- sedation
- dizziness
- ataxia
How are corticosteroids used to treat chronic pain?
Example?
- Reduce inflammation and swelling, reducing inflammatory mediators
- prevent release of prostaglandins
- Ex: dexamethasone
What are some adjuvant medications used to treat chronic pain?
- Muscle relaxants- reduce spasm
- cyclobenzaprine, skelaxin, baclofen, carisoprodol
- NMDA receptor antagonists
- Ketamine and dextromethorphan
- Alpha 2 agonist- inhibit nerve firing and release of substance P
- Clonidine, dexmeditomidine
- GABA agonists- inhibitory neurotransmitter which acts on spinal cord to prevent release of excitatory neurotransmitters
- Baclofen
- LAs
- Mexiletine, Tocainide
How do epidural steroid injections work to treat chronic pain?
- Provide high dose of steroid at the level of pathology to reduce swelling of the nerve root, block C-fibers, stabilize nerve membranes, and decrease ectopic discharges from inflamed tissue
What is a neurolytic block?
- Permanent destruction of the nerve
- Most common neurolytic blocks
- lumbar sympathetic chain
- celiac plexus
- hypogastric plexus
- ganglion impar (retroperitoneal plexus)
- intercostal blocks
How is spinal cord stimulation used to treat chronic pain?
uses?
- stimulating electrodes in the epidural space surrounding the entry level of the noxious input into the spinal cord
- activates the descending modulating system and therefore inhibits sympathetic outflow
- used for:
- phantom limb pain
- inschemic pain
- PVD
- spinal cord lesions
What are TENS?
- Transcutaneous electrical nerve stimulation
- hyperstimulation of the nervous system drowns out the pain
What is radiofrequency ablation?
- A procedure where dysfuntional tissue is ablated using microwave energy
- cryoneurolysis with cold-freeze
____-___% of cancer pain can be effectively treated with pharmacotherapy alone.
70-90%
____-____% of patients experiencing cancer-related pain do not receive effective analgesia.
40-50%
What is inadequate pain relief usually relataed to?
- poor pain assessment
- poor pain treatment plans
- lack of knowledge of analgesics available
- fear of addiction
- fear of respiratory depression
- side effects of pain treatment
What is the WHO analgesic ladder of pain management?
(picture)
What are the medications that go along with the old WHO three step model?
(picture)
